Background factors of male genital self-mutilation have been suggested in a small series of cases. A review of 110 cases in the literature revealed that guilt feelings associated with sexual conflicts were the most important factors in the act of psychotic self-mutilation and also related to religious psychotic experiences that were often the direct motives for the act. Self-mutilators with sexual guilt feelings were likely to mutilate themselves more severely than those without. Even excluding transsexuals, disturbance of sexual identity was most participating in the act of nonpsychotic self-mutilators. In addition to these, previous history of self-injury took part in the act independently. Male genital self-mutilation is exceedingly rare in psychiatric practice even if it is not as uncommon as the paucity of published literature on the subject would suggest. According to Blacker et al., the earliest report in English of male genital self-mutilation is Stroch's brief communication in 1901. Greilsheimer and Groves found 53 cases in the English literature that had been reported till 1979. We present a case report with male genital self-mutilation and examine the background factors of this phenomenon from a review of the literature. We used the literature files 'Medline' from 1979 to 1993 and the references of famous reports. In statistical analyses, we performed two-tailed t tests for continuous variables and chi 2 tests with Yates correction for categorical variables.